GRASSROOTS: The GMT Initiative Blog

Grassroots reports on the work of amfAR-supported research teams and advocates responding to the devastating impact of HIV among gay men, other men who have sex with men, and transgender individuals (collectively, GMT).

Thailand is striving to end its AIDS epidemic by 2030, in part by employing “test and treat” strategies to ensure at least 90% of individuals living with HIV know their status and that at least 90% of those diagnosed are linked to HIV treatment and care. While the country has made significant progress towards accomplishing these ambitious goals, it will not achieve them without reaching gay men, other men who have sex with men (MSM), and transgender individuals (collectively, GMT). However, only 29% of Thai MSM get tested for HIV annually, and many have never been tested at all. Until 2015, national statistics grouped transgender individuals with MSM, so less is known regarding their infection rates and risk behaviors.

“Thailand has diagnosed around 80% of people living with HIV, but it’s reaching that last 10–20% who we have not been able to reach in the past that is going to be hard,” says Dr. Nittaya Phanuphak from the Thai Red Cross AIDS Research Centre and the principal investigator for the amfAR implementation science study. “Traditional outreach strategies will not be sufficient.”

In the above video, Dr. Phanuphak and Tarandeep Anand, director of Adam’s Love, the popular online HIV outreach initiative targeting GMT individuals, discuss their amfAR-funded implementation science study investigating the best ways of reaching that remaining 20% and linking those who test positive to care. The study, which began enrolling participants in November 2015, will test three innovative HIV outreach models. Each targets a different subset of the GMT population, and together, the team hopes, the strategies can successfully access the hardest-to-reach GMT individual not reached through previous outreach efforts.

In one arm, outreach workers from community-based organizations—including Service Workers in Group/SWING and The Rainbow Sky Association of Thailand—are reaching out to sex workers and other GMT individuals who frequent areas of Bangkok known to be community “hot spots,” and then referring those who are interested to HIV care at community-run clinics. Testing and treatment services in the second arm are provided entirely online through the Adam’s Love website, which primarily reaches younger GMT individuals. Patients can chat with a counselor online, take an at-home HIV test with online guidance from the counselor, and, for those who test positive, fill prescriptions and monitor their lab results online through Asia’s first electronic health records system, which is being developed for the study with help from IBM.

The final arm is a hybrid of online outreach and offline clinic-based care. Patients in this arm first make contact with the team online through the Adam’s Love site, but then opt to receive testing and care in person. Those interested in a more private setting will be referred to a new Adam’s Love Clinic, which aims to appeal to discreet, harder-to-reach GMT individuals by providing private, appointment-only services from knowledgeable, GMT-friendly staff.

“This study will show what is working and what is not and who is being reached through each arm, so we know where and how the available funds should be spent in Thailand,” says Anand. “It could also be scalable and replicable in other countries.”